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Scrub typhus meningoencephalitis, a diagnostic challenge for clinicians: A hospital based study from North-East India
M D Jamil1, Masaraf Hussain2, Monaliza Lyngdoh1
1Department of Medicine, NEIGRIHMS, Shillong, Meghalaya, India.
Unlabelled:
Central nervous system (CNS) involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis.
Aims And Objectives:
To study the clinical feature, laboratory parameters and response to treatment of scrub typhus meningitis/meningoencephalitis.
Methods And Materials:
This is a hospital based prospective observational study from North Eastern India. Diagnosis was based on clinical features and positive serological test (Weil's Felix test and IgM antibody card test).
Results:
13 patients of scrub typhus with features of meningitis/meningoencephalitis were included. The mean duration of fever before presentation was 5.61±3.08 days and 4 (30.76 %) patients had eschar. Altered sensorium, headache, seizure and meningeal sign were present in 13 (100%), 13 (100%), 6 (46.15%) and 10 (76.92%) patients respectively. Mean CSF protein, glucose and Adenosine deaminase was 152.16±16.88mg/dl, 55.23±21.7mg/dl, and 16.98±7.37U/L respectively. Mean total count of CSF leukocyte and lymphocyte percentage was 46.07±131 cell/cumm and 98.66±3.09% respectively. Tablet doxycycline with or without injection azithromycin was used and that shows good response 15.38% of patients died and all of them had multi organ dysfunction.
Conclusion:
Meningoencephalitis is a common manifestation of scrub typhus and diagnosis requires high degree of clinical suspicion which if diagnosed early and specific treatment started, patients usually recover completely with few complications.
Insights
Scrub typhus can cause central nervous system (CNS) complications like meningoencephalitis. Early diagnosis and treatment with doxycycline or azithromycin lead to good patient outcomes.
Area of Science:
- Infectious Diseases
- Neurology
- Tropical Medicine
Background:
- Central nervous system (CNS) involvement is a recognized complication of scrub typhus.
- Manifestations range from mild meningitis to severe meningoencephalitis.
Purpose of the Study:
- To investigate the clinical features, laboratory findings, and treatment responses in scrub typhus patients with meningitis/meningoencephalitis.
Main Methods:
- A prospective observational study conducted in North Eastern India.
- Diagnosis confirmed by clinical presentation and serological tests (Weil-Felix and IgM antibody card test).
Main Results:
- 13 patients with scrub typhus meningoencephalitis were analyzed.
- Common symptoms included altered sensorium (100%), headache (100%), and meningeal signs (76.92%).
- Cerebrospinal fluid (CSF) analysis showed elevated protein and leukocyte counts, with a high lymphocyte percentage.
Conclusions:
- Meningoencephalitis is a frequent complication of scrub typhus, necessitating high clinical suspicion for early diagnosis.
- Prompt initiation of specific treatment, such as doxycycline or azithromycin, generally results in complete recovery with minimal complications.
